Abstract 16044: Association of Area Deprivation Index With Recurrent Cardiovascular Outcomes: Does Cardiac Rehabilitation Participation Mitigate Effects?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emily N Guhl ◽  
Jianhui Zhu ◽  
Amber Johnson ◽  
Utibe Essien ◽  
Floyd W Thoma ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Coronary Intervention ◽  
Primary Diagnosis ◽  
Cardiovascular Outcomes ◽  
Adverse Outcomes ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Coronary Syndrome ◽  
Regional Center ◽  
Health Promoting

Introduction: Neighborhood location impacts access to health-promoting resources and outcomes. Cardiac rehabilitation (CR) provides a multidisciplinary approach that improves cardiovascular outcomes. We evaluated the association of Area Deprivation Index (ADI) and cardiovascular events in individuals with incident Heart Failure (HF) or myocardial infarction (MI) and the modifying effect of CR. Methods: We identified an observational cohort admitted with primary diagnosis of 1) MI with percutaneous coronary intervention or 2) a primary diagnosis of incident HF from 2010-2018 at a multi-site regional center. We derived ADI from patient home address and then categorized into quartiles. Demographics, clinical covariates, and CR participation post-hospitalization were obtained from the electronic medical record. We compared rates of readmission for a cardiovascular primary diagnosis and mortality across ADI quartiles. Analyses were then stratified by CR participation. Results: In a cohort of 6957 (38.2% women, 88.7% white) with adjustment for covariates, increasing ADI was significantly associated with higher rates of cardiovascular rehospitalization (p<0.01), Acute Coronary Syndrome (ACS) rehospitalization (p=0.01), HF rehospitalization (p<0.01), and all-cause mortality (p=0.04), Table. When we stratified across CR participation, those with participation had significantly lower rehospitalizations (p<0.01) and mortality (p<0.01) when compared to the no CR group. There was no significant effect of ADI on outcomes in the CR group. Discussion: We found increased ADI was adversely associated with mortality and rehospitalizations in cardiac patients. For those participating in CR, there was 1) no significant effect of ADI and 2) decreased incidence of adverse outcomes vs. those who did not participate in CR. Given the benefit of CR participation on ADI’s adverse effect on outcomes, future interventions should focus on increasing CR participation.

scholarly journals Cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomised trial

Heart Asia ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. e011201
Author(s):  
Yotsawee Chotechuang ◽  
Arintaya Phrommintikul ◽  
Srun Kuanprasert ◽  
Roungtiva Muenpa ◽  
Jayanton Patumanond ◽  
...  
Keyword(s):  
Randomised Trial ◽  
Intervention Group ◽  
Coronary Intervention ◽  
Cardiovascular Outcomes ◽  
Intermediate Risk ◽  
Successful Therapy ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
Delayed Group ◽  
Coronary Events

BackgroundThe benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate the cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI after successful therapy with SK.MethodsWe randomly assigned low to intermediate Global Registry of Acute Coronary Events risk score to patients with STEMI who had successful treatment with full-dose SK at Lampang Hospital and Maharaj Nakorn Chiang Mai Hospital into early and delayed coronary intervention groups. The primary endpoints were 30-day and 6-month composite cardiovascular outcomes (death, rehospitalised with acute coronary syndrome, rehospitalised with heart failure and stroke).ResultsOne hundred and sixty-two patients were included in our study. At the 30 days, composite cardiovascular outcomes were 4.9% in the early coronary intervention group and 2.5% in the delayed group (p=0.682). At the 6 months, the composite cardiovascular outcomes were 16.1% in the early group and 6.2% in the delayed group (p=0.054).ConclusionsThe delayed coronary intervention (>24 hours) in low to intermediate STEMI after successful therapy with SK did not increase in short and long-term cardiovascular events compared with an early coronary intervention.Trial registration numberNCT02131103.

Bleeding and haemostasis disorders

2018 ◽  
Author(s):  
Pier Mannuccio Mannucci ◽  
Maddalena Lettino
Keyword(s):  
Artery Bypass ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
High Rate ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Preventive Strategy ◽  
Stent Deployment ◽  
Coronary Syndrome ◽  
Coronary Syndromes

The main cause of haemostasis defects and related bleeding complications in patients with acute coronary syndromes admitted to the intensive cardiac care unit is the use of multiple antithrombotic drugs, alone or concomitantly with invasive procedures such as percutaneous coronary intervention with stent deployment and coronary artery bypass surgery. These drugs, that act upon several components of haemostasis (platelet function, coagulation, fibrinolysis), are associated with bleeding complications, particularly in elderly patients (more so in women than in men), those who are underweight, and those with comorbid conditions such as renal and liver insufficiency and diabetes. The identification of patients at higher risk of bleeding is the most important preventive strategy. Red cell and platelet transfusions, which may become necessary in patients with severe bleeding, should be used with caution, because transfused patients with acute coronary syndrome have a high rate of adverse outcomes (death, myocardial infarction, and stroke).

scholarly journals Cardiac rehabilitation after percutaneous coronary intervention: Results from a nationwide survey

2017 ◽  
Vol 17 (3) ◽  
pp. 273-279 ◽  
Author(s):  
Siv JS Olsen ◽  
Henrik Schirmer ◽  
Kaare H Bønaa ◽  
Tove A Hanssen
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Cardiac Rehabilitation ◽  
Odds Ratio ◽  
Bypass Graft ◽  
Participation Rate ◽  
Coronary Intervention ◽  
Lower Probability ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Aim: The purpose of this study was to estimate the proportion of Norwegian coronary heart disease patients participating in cardiac rehabilitation programmes after percutaneous coronary intervention, and to determine predictors of cardiac rehabilitation participation. Methods: Participants were patients enrolled in the Norwegian Coronary Stent Trial. We assessed cardiac rehabilitation participation in 9013 of these patients who had undergone their first percutaneous coronary intervention during 2008–2011. Of these, 7068 patients (82%) completed a self-administered questionnaire on cardiac rehabilitation participation within three years after their percutaneous coronary intervention. Results: Twenty-eight per cent of the participants reported engaging in cardiac rehabilitation. Participation rate differed among the four regional health authorities in Norway, varying from 20%–31%. Patients undergoing percutaneous coronary intervention for an acute coronary syndrome were more likely to participate in cardiac rehabilitation than patients with stable angina (odds ratio 3.2; 95% confidence interval 2.74–3.76). A multivariate statistical model revealed that men had a 28% lower probability ( p<0.001) of participating in cardiac rehabilitation, and the odds of attending cardiac rehabilitation decreased with increasing age ( p<0.001). Contributors to higher odds of cardiac rehabilitation participation were educational level >12 years (odds ratio 1.50; 95% confidence interval 1.32–1.71) and body mass index>25 (odds ratio 1.19; 95% confidence interval 1.05–1.36). Prior coronary artery bypass graft was associated with lower odds of cardiac rehabilitation participation (odds ratio 0.47; 95% confidence interval 0.32–0.70) Conclusion: The estimated cardiac rehabilitation participation rate among patients undergoing first-time percutaneous coronary intervention is low in Norway. The typical participant is young, overweight, well-educated, and had an acute coronary event. These results varied by geographical region.

Abstract P338: Adverse Outcomes Following Percutaneous Coronary Intervention in Insulin Dependent and Non-Insulin Dependent Diabetes Mellitus

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Michael S Scholfield ◽  
Ragu Murthy ◽  
Burhan Mohamedali ◽  
Sloane McGraw ◽  
Anupama Shivaraju ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Glycemic Control ◽  
Coronary Intervention ◽  
Cardiovascular Outcomes ◽  
Adverse Outcomes ◽  
Diabetic Patients ◽  
Percutaneous Coronary ◽  
Insulin Dependent ◽  
The Impact ◽  
Niddm Patients

Background: ACC guidelines suggests late outcomes in diabetic patients after percutaneous coronary intervention (PCI) are similar to non-diabetics if the hgbA1C can be maintained less than 7.0%. To achieve this level of glycemic control many patients require the addition of insulin. The differences in outcomes amongst insulin dependent (IDDM) and non-insulin dependent (NIDDM) patients are not well known. We wish to analyze the cardiovascular (CV) outcomes and glycemic control of diabetic patients 6 months post PCI stratified by insulin usage. Methods: We conducted a retrospective cohort study investigating the impact of DM on clinical outcomes in patients who underwent a PCI at a Veterans Health Institution from September 2004 to March 2009. Adverse cardiovascular outcomes (death, myocardial infarct, revascularization, cardiac hospitalization, and combined outcomes) six months post-PCI were recorded and compared in IDDM and NIDDM patients. Data pertaining to glucose levels, HgbA1C, lipids, and blood pressure were also collected. Results: Of the 771 unique patients in our analysis, 302 had DM of which, 132(44%) were on insulin and 169(56%) were on oral medications. Although not statistically significant, in IDDM patients there was an increased rate of death, MI, cardiac hospitalization, and combined outcomes. HgbA1C and glucose values in IDDM were significantly higher pre and post-PCI. Conclusion: Our study suggested that both IDDM and NIDDM groups had poor glycemic control, however, IDDM patients were less controlled. Although lack of power in our study may have led to our inability to detect statistically significant differences in adverse CV outcomes we can see a trend toward worse outcomes in the IDDM group. Increased attention to promote tighter glycemic control particularly among IDDM veterans is warranted. We can conclude that more attention needs to be paid to diabetics patients, especially IDDM patients, to maintain a tighter glycemic control and hence reduce adverse cardiovascular outcomes post PCI.

scholarly journals Association of Left Coronary Dominance with In- Hospital Adverse Outcomes after Percutaneous Coronary Intervention in Patients with Acute Coronary Syndrome

2017 ◽  
Vol 9 (2) ◽  
pp. 129-134
Author(s):  
Muhammad Azmol Hossain ◽  
STM Abu Azam ◽  
Md Khalequzzaman ◽  
Tariq Ahmed Chowdhury ◽  
Abul Hasnat Md Jafar ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Ventricular Failure ◽  
Hospital Outcome ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Dominance

Background: Coronary dominance affects on in-hospital outcomes of patients with acute coronary syndrome and also affects the outcome following percutaneous coronary intervention. Left dominant anatomy is believed to be associated with worse prognoses for patients with acute coronary syndrome undergoing percutaneous coronary. This study evaluated the manner in which coronary dominance affects in-hospital adverse outcomes of acute coronary syndrome (ACS) patients who underwent percutaneous coronary intervention (PCI).Methods: Data were analyzed from 149 ACS patients who underwent PCI between November 2014 and October 2015 at National Institute of Cardiovascular Diseases (NICVD), Dhaka. The patients were grouped based on diagnostic coronary angiograms performed prior to PCI; those with right dominant plus co-dominant anatomy (RD+Co group) and those with left dominant anatomy (LD group).Results: Total adverse in-hospital outcome is 8.7% patients. In LD group 23.1% patients were experienced adverse in-hospital outcome, on the contrary 5.7% of the patients with RD+Co group did have such experience. About 2.7% patients developed arrhythmia, 2.7% cardiogenic shock, 2% acute left ventricular failure and 0.7% ischaemic chest pain of the both groups. Among them arrhythmia, acute left ventricular failure and cardiogenic shock were more common in LD group than RD+Co (7.7% vs. 1.6%, 7.7% vs. 0.8% and 7.7% vs. 1.6%) group. Multivariate logistic regression analysis revealed that smoking, diabetes mellitus and left coronary dominance were the independent predictors for developing adverse in-hospital outcome with ORs being 1.317, 1.074 and 6.553 respectively (p <0.05).Conclusion: Patients of left coronary dominant had higher in-hospital adverse outcome compared with patients of right dominant plus co-dominant in a population with acute coronary syndrome who underwent percutaneous coronary intervention and left dominant anatomy was an independent predictor for developing adverse in-hospital outcome.Cardiovasc. j. 2017; 9(2): 129-134

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